Objective To explore the feasibility,the safety,D2 lymph node dissection and clinical outcomes of laparoscope-assisted radical gastrectomy lot advanced gastric cancer.Methods The clinica data of 47 cases with advanced gastric treated with laparoscope-assisted radical gastrectomy were analyzed retrospectively.Results Laparoscope-assisted radical gastrectomy,proximal gastrectomy in 25 cases,distalgastrectomy in 11 cases,total gastrectomy in 10 cases;46 were performed Laparoscope-assisted surgery radical gastrectomy successfuly,and the other one was converted to abdominal opening.The average operative time for proximal gastrectomy,distal gastrectomy,and total gastrectomy was(220±55)min,(284±37)min,and (330±50)min,respectivel.The average blood loss in proximal gastrectomy,distal gastrectomy,and total gastrectomy was(150±87)ml,(120±70)ml,and(330±50)ml respectively.The average time of proximal gastrectomy for gastrointestinal function recovery,for the patients to stand up,and for the postoperative hospital stay was(5.1±0.5)d,(3.2±0.8)d and(9.0±1.5)d.The average time of distal gastrectomy for gastrointestinal function recovery,for the patients to stand up,and for the postoperative hospital stay was (4.0±0.8)d,(3.2±1.5)d and(9.0±2.0)d.The average time of total gastrectomy for gastrointestinal function recovery,for the patients to stand up,and for the postoperative hospital stay was(4.1±0.8)d,(3.2±0.8)d and(9.5±2.0)d.The mean total number of retrieved lymph nodes was(21.95±9.88),and the lengths of proximal and distal margins to the tumor were(6.41±2.13)cm and(6.22±1.98)cm respectively.No postoperative deaths or anastomtic fistulas were found.Its short-term outcomes were satisfactory.Conclusion Laparoscope-assisted radical gastrectomy with D2 lymphadenectomy is safe,feasible,which achieves adequate cancer clearance,but the long-term outcome is needed to be observed.

Objective To evaluate the efficacy and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) for the prevention of endometriosis recurrence after conservative surgery.Methods We enrolled patients with medium and severe endometriosis who underwent conservative surgical treatment.All patients were divided into 3 groups:group A in which the patients were administered with 3 cycles of gonadotropin-releasing hormone agonist (GnRH-a) 5 days postoperatively,group B in which the patients were administered with the LNG-IUS 5 days postoperatively,and group C in which the patients were administered with 3 cycles of GnRH-a 5 days postoperatively and the LNG-IUS on the day of the third GnRH-a injection.All patients were followed up at 3,6,12,and 24 months postoperatively.Dysmenorrhea relief was evaluated,and pelvic ultrasound and serum CA125 detection were performed.All treatment-related adverse reactions were recorded.Results Eighty-three patients were included with 21,29,and 33 in groups A,B,and C,respectively.The VAS scores in all 3 groups after 3 months were significantly lower than those obtained preoperatively (P ＜ 0.05).No significant difference was found in the VAS scores after 6 and 12 months among the 3 groups (P ＞ 0.05).After 24 months,the VAS scores in group A were significantly higher than those in the other 2 groups (P ＜ 0.05).Endometriosis recurrence was found in 8 patients after 24 months,with 4 (19.05％),3 (10.71％),and 1 (3.13％) such patient in groups A,B,and C,respectively (P ＜ 0.05).No serious side effects were found.Conclusion Postoperative application of LNG-IUS can effectively prevent recurrence and relieve pain caused by endometriosis,and its combined application with GnRH-a can improve efficacy.

Objective: To investigate the sexual function, urinary function and quality of life in patients of ulcerative colitis(UC) and familial adenomatous polyposis(FAP) after total proctocolectomy and ileal pouch anal anastomosis (IPAA). Methods: The clinical data of patients with UC and FAP undergoing IPAA at Zhongnan Hospital of Wuhan University from Jan 2006 to Sep 2018 were reviewed , postoperative sexual function, urinary function, and long-term quality of life were assessed. Results: There were 45 patients with median age of 35 years , median follow-up time of 31 months. 18 were UC, 27 were FAP, 5 did 1-stage surgery, 37 did 2-stage surgery, 3 for 3-stage surgery, 13 underwent open surgery, and 32 underwent laparoscopic surgery. 7 patients suffered sexual dysfunction after IPAA, and there was no statistical difference between male and female (P=0.992), UC and FAP (P=0.153), 1-stage , 2-stage , and 3-stage surgery (P=0.363) , with statistically significant difference between the open group and the laparoscopic group (P=0.025). 6 patients complicated with urinary dysfunction after IPAA , and there was no statistical difference between male and female (P=0.562), UC and FAP (P=0.325), 1-stage, 2-stage, and 3-stage surgery (P=0.286) , with statistically significant difference between the open group and the laparoscopic group (P=0.007). The Cleveland Global Quality of Life (CGQL) score after IPAA was 0.696±0.085. There were no statistical difference on CGQL scores in males and females (P=0.635), UC and FAP (P=0.664), 1-stage, 2-stage, and 3-stage (P>0.05), open group and laparoscopic group (P=0.205), postoperative long-term QOL was significantly associated only with age at the time of surgery (P=0.001). Conclusions Compared with open surgery, laparoscopic TPC-IPAA patients had better postoperative sexual function and urination function.